Trigger Finger Treatment

Trigger Finger Treatment - An Outcomes Study. Comparing 6 Traditional Treatment Techniques

Trigger finger is a common disorder of the hand which causes pain at the A1 pulley, inflammation, stiffness and/or snapping during movement. This observational study compared all of the possible treatments and combinations of treatments for trigger finger at the A1 pulley, including surgery, cortisone injections and hand therapy.

Study Overview

• Status: Completed
• Conditions: Trigger Finger; Trigger Digit; Stenosing Tenosynovitis
• Intervention / Treatment: Procedure: surgery; Procedure: corticosteroid injections; Other: Hand Therapy; Other: Modality Hand Therapy

Detailed Description

Trigger finger is a common disorder of the hand which causes pain at the A1 pulley, inflammation, stiffness or snapping during movement. This can be very debilitating. Current treatment includes local steroid injection, oral NSAIDS, resting orthoses, physical or occupational therapy and surgical intervention. The aim of this prospective study with an observational design was to determine the outcome between surgical, hand therapy rehabilitation, and corticosteroid injection interventions for trigger finger. There were 6 treatment groups: surgery, corticosteroid injection, 1 visit of hand therapy for orthosis fabrication and therapeutic exercise, hand therapy in combination with cortisone injection, Modality hand therapy alone (ongoing visits) or with corticosteroid injections.

• Study Type: Observational
• Enrollment (Actual): 86

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

patients undergoing medical treatment or hand therapy for trigger finger in digits #2-5 at the hand clinic. Patients were dropped from the study if they had changed to a different treatment.

Description

Inclusion Criteria:

• trigger finger in digit 2-5

Exclusion Criteria:

• if prior treatment for trigger finger, or Trigger thumb

Study Plan

How is the study designed?

Number of groups / cohorts

6

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Surgery; Patients who underwent surgical release of A1 pulley	Procedure: surgery; A1 pulley release of finger
corticosteroid injections only; Patients who underwent local corticosteroid injections only, and no other treatment	Procedure: corticosteroid injections; corticosteroid injection to A1 pulley
hand therapy only occupational/physical; 1 visit: orthosis fabrication, range of motion, nodule and ice massage.	Other: Hand Therapy; orthosis fabrication, therapeutic exercise for range of motion to digits, ice massage, nodule massage, patient education,; Other Names: physical therapy; occupational therapy
Injection and Hand therapy; This group of participants received a combination of corticosteroid injection in the affected finger and one visit of hand therapy.	Procedure: corticosteroid injections; corticosteroid injection to A1 pulley; Other: Hand Therapy; orthosis fabrication, therapeutic exercise for range of motion to digits, ice massage, nodule massage, patient education,; Other Names: physical therapy; occupational therapy
Modality Hand Therapy; Ongoing hand therapy treatment, which included the above plus modalities such as ultrasound or iontophoresis.	Other: Modality Hand Therapy; orthosis fabrication, therapeutic exercise for range of motion to digits, ice massage, nodule massage, patient education, plus modalities such as ultrasound, iontophoresis
Injection and Modality Hand Therapy; Ccombination of local cortiscosteroid injection to the affected digit and ongoing hand therapy with modalities.	Procedure: corticosteroid injections; corticosteroid injection to A1 pulley; Other: Modality Hand Therapy; orthosis fabrication, therapeutic exercise for range of motion to digits, ice massage, nodule massage, patient education, plus modalities such as ultrasound, iontophoresis

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Functional use using Quick DASH 6 weeks	Change from baseline to 6 weeks Quick DASH	Day 1, 6 weeks
Change in Functional use using Quick DASH 3 months	Change from baseline to 3 months Quick DASH	Day 1, 3 months
Change in Functional use using Quick DASH 6 months	Change from baseline to 6 months Quick DASH	Day 1, 6 months
Change in Edema 6 weeks	Baseline to 6 weeks Circumferential measurement in centimeters of the proximal phalanx	day 1, 6 weeks
Change in Edema 3 months	Baseline to 3 months weeks Circumferential measurement in centimeters of the proximal phalanx	day 1, 3 months
Change in Edema 6 months	Baseline to 6 months weeks Circumferential measurement in centimeters of the proximal phalanx	day 1, 6 months
Change in Pain on a likert scale 6 weeks	Baseline to 6 weeks pain on a 0-10 scale	1 day, 6 weeks
Change in Pain on a likert scale 3 months	Baseline to 3 months pain on a 0-10 scale	1 day, 3 months
Change in Pain on a likert scale 6 months	Baseline to 6 months pain on a 0-10 scale	1 day, 6 months
Change in Range of motion 6 weeks	Baseline to 6 weeks flexion and extension range of motion at metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) using a finger goniometer.	1 day, 6 weeks
Change in Range of motion 3 months	Baseline to 3 months flexion and extension range of motion at metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) using a finger goniometer.	1 day, 3 months
Change in Range of motion 6 months	Baseline to 6 months flexion and extension range of motion at metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) using a finger goniometer.	1 day, 6 months
Change in Severity or Grade of triggering 6 weeks	Baseline to 6 weeks Using the scale by Patel and Bassini to measure the amount of triggering 1=normal joint, 6=locked in flexion	1 day, 6 weeks
Change in Severity or Grade of triggering 3 months	Baseline to 3 months Using the scale by Patel and Bassini to measure the amount of triggering 1=normal joint, 6=locked in flexion	1 day, 3 months
Change in Severity or Grade of triggering 6 months	Baseline to 6 months Using the scale by Patel and Bassini to measure the amount of triggering 1=normal joint, 6=locked in flexion	1 day, 6 months

Collaborators and Investigators

• Sponsor: University of Massachusetts, Lowell
• Collaborators: University of Massachusetts, Worcester

Publications and helpful links

General Publications

• Lewis E, Fors L, Tharion WJ. Interrater and intrarater reliability of finger goniometric measurements. Am J Occup Ther. 2010 Jul-Aug;64(4):555-61. doi: 10.5014/ajot.2010.09028.

Study record dates

Study Major Dates

• Study Start (ACTUAL): December 10, 2007
• Primary Completion (ACTUAL): December 8, 2012
• Study Completion (ACTUAL): December 8, 2012

Study Registration Dates

• First Submitted: February 8, 2019
• First Submitted That Met QC Criteria: February 18, 2019
• First Posted (ACTUAL): February 20, 2019

Study Record Updates

• Last Update Posted (ACTUAL): February 20, 2019
• Last Update Submitted That Met QC Criteria: February 18, 2019
• Last Verified: February 1, 2019

More Information

Terms related to this study

• Keywords: physical therapy; treatment outcome; occupational therapy; hand therapy
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Muscular Diseases; Tendinopathy; Tenosynovitis; Trigger Finger Disorder; Tendon Entrapment
• Other Study ID Numbers: H-12583

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: There are no plans for sharing the IPD

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No